Cigarettes are the leading preventable cause of morbidity and mortality in the US, and though quitting is the
optimal method to reduce smoking-related harms, most smokers are unable to quit. Smokers who are unable
to quit but wish to reduce potential harms of smoking may consider switching to noncombustible tobacco
products such as smokeless tobacco or electronic cigarettes. However, unintended consequences such as
dual use may mitigate the potential of these noncombustible products to reduce smoking -related harms. The
long-term goal is to reduce the health and economic burden caused by cigarette smoking. The overall objective
in this application is to characterize product transitions among cigarette smokers to evaluate the factors
associated with transitioning to noncombustibles and assess the potential of noncombustibles as a harm
reduction strategy. The transition model outlines four trajectories that a smoker may follow – continued
smoking (least optimal outcome), complete cessation (most optimal outcome), exclusive noncomb ustible use
(possible harm reduction) or dual/poly tobacco use (unlikely to be harm reduction). These trajectories will be
evaluated through a secondary data analysis using the Population Assessment of Tobacco and Health Study –
a longitudinal, nationally representative dataset on tobacco use behaviors and health. This project fills a gap by
defining who is switching to noncombustible products, which products and features may lead them to
successfully switch, and how their health and exposure to biomarkers changes as a result of switching
products. Aim 1 is to identify personal characteristics associated with switching from cigarettes to
noncombustibles – focusing on sociodemographic characteristics, smoking history, harm perceptions, and
exposure to messaging. Aim 2 is to characterize product characteristics associated with switching from
cigarettes to noncombustibles – focusing both on cigarette characteristics and noncombustible characteristics
(e.g., flavor, nicotine content) that facilitate switching. Aim 3 is to examine health outcomes and exposure
biomarkers in smokers that have switched to noncombustible products – to determine if these transitions result
in meaningful improvements to health. This project is responsive to FDA Center for Tobacco Products research
priorities relating to behavior and health effects, such as the impact of product characteristics on tobacco use
behaviors and human health. This project is innovative because it includes comprehensive assessment of
factors associated with switching to noncombustibles using a large, nationally representative dataset. This
project is impactful because it will evaluate the utility of noncombustibles as a harm reduction strategy.
Successful completion of this project will generate data on potential targets for intervention and product
regulation that can benefit public health by reducing the immense societal health and economic costs
associated with cigarette smoking.
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